Tall Cell Variant of Papillary Thyroid Carcinoma

We retrospectively reviewed the clinical and sonographic features of 8 patients with 10 tall cell variants of papillary thyroid carcinoma. The mean age of the patients was 57 years (range, 34–72 years). The tumor sizes varied. Of the 8 patients, 5 had symptomatic masses, and 3 had incidentalomas. Three patients had recurrences and 1 died of pulmonary metastasis within a mean time of 30 months. The tall cell variants often appeared as microlobulated markedly hypoechoic nodules with microcalcifications and extrathyroidal extension on sonography and were always associated with lymph node metastasis. The tall cell variant of papillary thyroid carcinoma should be included in the differential diagnosis of an aggressive thyroid tumor with symptoms and cervical nodal metastasis.     

Sonographic Features of Follicular Variant Papillary Thyroid Carcinomas in Comparison With Conventional Papillary Thyroid Carcinomas

Objective. The purpose of this study was to compare the sonographic features as well as the results of fine-needle aspiration biopsy (FNAB) of follicular variant papillary thyroid carcinoma (FVPTCs) and conventional papillary thyroid carcinoma (PTCs). Methods. Forty patients with 44 FVPTCs and 59 patients with 74 conventional PTCs were enrolled in this study. The sonographic features, sonographic gradings, and FNAB results were compared between the two groups. Results. The mean nodule size of FVPTCs was larger than that of conventional PTCs (17.70 versus 10.53 mm; P < .001). Sonographic features of an ovoid-to-round shape (95% versus 73%), isoechogenicity (52% versus 8%), and a hypoechoic halo (25% versus 3%) were more frequent in FVPTCs than conventional PTCs (P < .001). Sonographic features of a taller-than-wide shape (5% versus 22%), a spiculated margin (7% versus 32%), marked hypoechogenicity (5% versus 38%), and microcalcification (7% versus 24%) were rarer in FVPTCs than conventional PTCs (P < .05). The incidence of a sonographically malignant grade was also lower in FVPTCs (48%) than conventional PTCs (81%; P < .001). A diagnosis of PTC on FNAB of FVPTCs was less common than that of conventional PTCs (28% versus 56%; P = .0393); however, a diagnosis of an indeterminate cytologic type such as atypical cells or follicular lesions in FVPTCs was higher than that in conventional PTCs (46% versus 19%; P = .0418). Conclusions. Follicular variant papillary thyroid carcinomas show a relatively larger size, more benign sonographic features, a lower incidence of a sonographically malignant grade, and a lower diagnostic rate of PTC on FNAB compared with conventional PTCs.     

Sonographic and Cytopathologic Correlation of Papillary Thyroid Carcinoma Variants

Papillary thyroid carcinoma (PTC) is the most common thyroid cancer and constitutes more than 70% of thyroid malignancies. Although TNM staging is the most widely used parameter for determination of therapeutic plans, recent studies have suggested that different histopathologic variants of PTC can also have different clinical courses and patient prognoses. Sonographic criteria for PTC are well established and include a taller‐than‐wide shape, an irregular margin, microcalcifications, and marked hypoechogenicity. The role of sonography has expanded to enable the characterization of PTC variants based on their sonographic features. Tall cell and diffuse sclerosing variants appear to have more aggressive clinical courses with unfavorable prognoses, whereas the more recently described cribriform‐morular and Warthin‐like variants have relatively indolent clinical courses. The prognoses of patients with follicular, solid, columnar cell, and oncocytic variants are still controversial and may be similar to the prognosis of conventional PTC. Understanding the sonographic characteristics of PTC variants with clinicopathologic correlation may be helpful for suggesting an appropriate treatment plan.     

Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma

The purpose of this pictorial essay is to show the limitations of sonography and complementary usefulness of specimen radiography in detecting microcalcifications of the diffuse sclerosing variant of papillary thyroid carcinoma, which mostly manifests as diffusely scattered microcalcifications in the thyroid gland.     

Coexistence of Papillary Thyroid Cancer and Hashimoto Thyroiditis in Children

This report documents 3 pediatric papillary thyroid carcinoma cases with associated Hashimoto thyroiditis. In all 3 cases, hypoechoic nodules accompanied by multiple echogenic spots were noted on sonography of the thyroid. Hashimoto thyroiditis was suspected on the basis of positive thyroid autoantibody test results and pathologic examinations of thyroidectomy specimens, which revealed chronic thyroiditis with lymphocytic infiltration as the background of papillary thyroid carcinoma development. The potential for papillary carcinoma development warrants close follow‐up, and meticulous sonographic examinations must be performed in children with Hashimoto thyroiditis.     

Sonographic Findings of the Diffuse Sclerosing Variant of Papillary Carcinoma of the Thyroid

Objective. The purpose of this series was to describe the sonographic findings of the diffuse sclerosing variant of papillary carcinoma (DSVPC) of the thyroid. Methods. The sonographic findings of 8 patients with DSVPC of the thyroid were retrospectively analyzed. The following sonographic features of DSVPC of the thyroid were analyzed: extent of disease, echogenicity, microcalcifications, and cervical metastatic lymphatic nodes. Results. Three of 8 cases were unilateral, and 5 were bilateral. All 8 cases showed diffuse involvement of at least 1 entire thyroid lobe. Five of 8 cases showed hyperechogenicity, and 3 showed hypoechogenicity. Seven of 8 cases showed diffuse scattered microcalcifications, and 1 showed locally distributed microcalcifications. All 8 cases showed cervical metastatic lymph nodes. Conclusions. The sonographic findings of DSVPC of the thyroid are characteristic, and sonography is a useful imaging tool in diagnosis of DSVPC of the thyroid.     

Sonographic Features of the Follicular Variant of Papillary Thyroid Carcinoma

Objective. The purpose of this study was to evaluate the sonographic findings of the follicular variant of papillary thyroid carcinoma (FVPTC) and to assess the role of preoperative fine‐needle aspiration biopsy (FNAB). Methods. The sonographic findings of 27 thyroid nodules in 26 patients (2 male and 24 female; mean age, 45 years) with surgically proven FVPTC were reviewed retrospectively. Findings were categorized according to the echogenicity, margin, shape, and presence of microcalcifications. Malignant findings included marked hypoechogenicity, irregular or microlobulated margins, a taller‐than‐wide shape, and microcalcifications. Thyroid nodules with a single malignant finding as described above were classified as malignant. All patients underwent sonographically guided FNAB, and the sensitivity of the cytologic results was calculated. Results. Lesion sizes varied from 3 to 34 mm (mean, 15.2 mm), and lesions were most commonly solid (23 [85.2%]), hypoechoic (14 [51.9%]), and oval (17 [63%]) with well‐defined margins (14 [51.9%]) and no microcalcifications (23 [85.2%]). Eighteen lesions (66.7%) were correctly classified as malignant, whereas 9 (33.3%) were classified as benign on the basis of sonographic criteria. Twenty‐four samples were adequate for cytologic examination, and 3 were inadequate. Twenty‐one of 24 diagnostic cytologic results (87.5%) were suspicious for papillary carcinoma (5 of 21 [20.8%]) or malignant (16 of 21 [66.7%]), whereas 3 lesions (12.5%) had benign results. The sensitivity of FNAB was 77.8% (21 of 27). Conclusions. The follicular variant of papillary thyroid carcinoma tends to have relatively benign sonographic features, such as hypoechogenicity, well‐defined margins, an oval shape, and no microcalcifications, but most lesions were correctly classified as malignant by both sonography and FNAB. The possibility of FVPTC should be considered when thyroid nodules with a relatively benign sonographic appearance have suspicious or malignant FNAB results     

基于C-TIRADS阳性特征的超声灰度比值在鉴别甲状腺皱缩结节与甲状腺乳头状癌中的应用价值

目的 探讨超声灰度比值(UGSR)在甲状腺皱缩结节(CTN)及甲状腺乳头状癌(PTC)中的鉴别效能及联合C-TIRADS的应用价值。方法 2018年1月至2022年12月在中国人民解放军东部战区总医院秦淮医疗区诊疗的PTC受试者86例(86枚结节)、CTN受试者78例(78枚结节)。比较结节位置、最大径、C-TIRADS阳性特征差异;测量结节整体灰度值、内部灰度值及边缘灰度值,计算UGSR并比较差异。采用Logistic回归分析筛选影响CTN的独立危险因素,绘制ROC曲线及计算曲线下面积(AUC)。使用UGSR重分析基于C-TIRADS的结节术前诊断,并评价效能。结果 与PTC相比,CTN在C-TIRADS阳性特征及整体灰度值中无显著差异(P＞0.05),而在内部灰度值、边缘灰度值及UGSR中具有显著性差异(P＜0.05)。Logistic回归分析显示UGSR是CTN的独立影响因素(OR=1.015,95%CI：0.995-1.026,P =0.007),且AUC最高(0.867)。与术前C-TIRADS评分相比,UGSR提高了C-TIRADS评分的准确性(PTC：χ₂ =17.964,P =0.009;CTN：χ₂ =10.904,P =0.010)。结论 UGSR具有良好的鉴别CTN与PTC的效能,并有效地提高了C-TIRADS诊断的准确性,值得在临床进一步推广。     

超声引导下FNAC联合BRAF V600E检测 在甲状腺乳头状癌诊断中的应用价值

目的 探讨超声引导下细针穿刺细胞学(fine-needle aspiration cytology, FNAC)联合BRAF V600E检测诊断甲状腺乳头状癌的应用价值。方法 回顾性分析207例甲状腺乳头状癌患者资料,将FNAC细胞学检查和BRAF V600E突变检查,以手术标本病理组织学诊断为标准,进行统计分析。结果 FNAC细胞学检查诊断甲状腺乳头状癌的灵敏度为70.7%,准确率为74.4%;BRAF V600E的灵敏度为64.6%,准确率为69.1%。两种方法联合后灵敏度为86.2%(156/181),准确率为87.9%(182/207),灵敏度、准确率均显著提高(P < 0. 001)。结论 超声引导下FNAC联合BRAF V600E检测可提高甲状腺乳头状癌的诊断准确率。